Fourth branchial pouch sinus: diagnosis and treatment

Otolaryngol Head Neck Surg. 1991 Jul;105(1):44-50. doi: 10.1177/019459989110500107.


The fourth branchial pouch sinus (FBPS) is a rare translaryngeal anomaly with diverse manifestations, including neonatal stridor and recurrent deep neck infection. Review of the world literature reveals 23 reports of sinuses consistent with fourth pouch origin. We present two additional cases, including the only example of a right-sided FBPS. Retrograde excision, beginning at the piriform apex, ensures complete removal of the tract and protection of the recurrent nerve. The posterior border of the thyroid ala must be resected or retracted for adequate exposure. Failure to remove the translaryngeal portion of the tract almost guarantees recurrence.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Branchioma* / diagnosis
  • Branchioma* / diagnostic imaging
  • Branchioma* / surgery
  • Child, Preschool
  • Head and Neck Neoplasms* / diagnosis
  • Head and Neck Neoplasms* / diagnostic imaging
  • Head and Neck Neoplasms* / surgery
  • Humans
  • Male
  • Radiography